Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática

El estudio presenta los resultados de la revisión sistemática sobre la estimulación cognitiva en el trastorno cognitivo mayor por enfermedad de Alzheimer. Se desprende que ésta encabeza las intervenciones no farmacológicas de preferencia, estando dirigida a promover el mantenimiento del estado cogni...

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Autores:
Orejarena-Ballestas, María Camila
QUIÑONEZ PEREZ, ANA MILENA
Marín-Gutiérrez, Alejandro
Tipo de recurso:
Article of investigation
Fecha de publicación:
2017
Institución:
Corporación Universitaria del Caribe - CECAR
Repositorio:
Repositorio Digital CECAR
Idioma:
spa
OAI Identifier:
oai:repositorio.cecar.edu.co:cecar/3100
Acceso en línea:
https://repositorio.cecar.edu.co/handle/cecar/3100
https://doi.org/10.21892/01239813.372
Palabra clave:
estimulación cognitiva
enfermedad de Alzheimer
trastornos neurocognitivo mayor
demencia
cognitive stimulation
Alzheimer disease
mayor cognitive disease
dementia
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openAccess
License
http://purl.org/coar/access_right/c_abf2
id RepoCECAR2_cc3cb6072d7f74e773f9c1e9a20748ba
oai_identifier_str oai:repositorio.cecar.edu.co:cecar/3100
network_acronym_str RepoCECAR2
network_name_str Repositorio Digital CECAR
repository_id_str
dc.title.none.fl_str_mv Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
dc.title.translated.none.fl_str_mv Cognitive stimulation in Alzheimer disease patients: a systematical review
title Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
spellingShingle Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
estimulación cognitiva
enfermedad de Alzheimer
trastornos neurocognitivo mayor
demencia
cognitive stimulation
Alzheimer disease
mayor cognitive disease
dementia
title_short Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
title_full Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
title_fullStr Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
title_full_unstemmed Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
title_sort Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemática
dc.creator.fl_str_mv Orejarena-Ballestas, María Camila
QUIÑONEZ PEREZ, ANA MILENA
Marín-Gutiérrez, Alejandro
dc.contributor.author.none.fl_str_mv Orejarena-Ballestas, María Camila
QUIÑONEZ PEREZ, ANA MILENA
Marín-Gutiérrez, Alejandro
dc.subject.proposal.none.fl_str_mv estimulación cognitiva
enfermedad de Alzheimer
trastornos neurocognitivo mayor
demencia
cognitive stimulation
Alzheimer disease
mayor cognitive disease
dementia
topic estimulación cognitiva
enfermedad de Alzheimer
trastornos neurocognitivo mayor
demencia
cognitive stimulation
Alzheimer disease
mayor cognitive disease
dementia
description El estudio presenta los resultados de la revisión sistemática sobre la estimulación cognitiva en el trastorno cognitivo mayor por enfermedad de Alzheimer. Se desprende que ésta encabeza las intervenciones no farmacológicas de preferencia, estando dirigida a promover el mantenimiento del estado cognitivo de las personas con condiciones neurodegenerativas. Se evidencia una tendencia a comprobar la eficacia de esta terapia, teniendo efectos positivos en la calidad de vida del paciente. Sin embargo, la heterogeneidad metodológica conlleva a diversas falencias estadísticas en varios estudios, más una ausencia de evaluación de eficacia de las tareas específicas incluidas en estos programas, lo que limita la comprobación definitiva de la eficacia de estas terapias. Se discute la relevancia del estudio del campo, considerando el contexto nacional que enmarca la labor de los profesionales, y la problemática de salud pública que caracteriza esta enfermedad.
publishDate 2017
dc.date.issued.none.fl_str_mv 2017-12-15
dc.date.accessioned.none.fl_str_mv 2022-09-14T13:45:18Z
dc.date.available.none.fl_str_mv 2022-09-14T13:45:18Z
dc.type.spa.fl_str_mv Artículo de revista
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https://doi.org/10.21892/01239813.372
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dc.relation.references.spa.fl_str_mv Aguirre, E.; Hoare, Z.; Streater, A.; Spector, A.; Woods, B.; Hoe, J. y Orrell, M. (2013). Cognitive stimulation therapy (CST) for people with dementia. Who benefits most? International Journal of Geriatric Psychiatry, 28(3), 284-290. doi: 10.1002/gps.3823.
Alzheimer’s Association. (2017). Alzheimer's disease facts and figures. Alzheimer's y Dementia, 13(4), 325-373.
Arkin, S.M. (2001). Alzheimer rehabilitation by students: interventions and outcomes. Neuropsychological Rehabilitation, 11(3/4), 273-317. doi: 10.1080/09602010143000059.
Asociación Americana de Psiquiatría. (2014). Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5®). Madrid: Editorial Médica Panamericana.
Asociación Americana de Psiquiatría. (2014). Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5®). Madrid: Editorial Médica Panamericana.
Asociación de Alzheimer (2010). Reporte Especial: Raza, Etnicidad y la Enfermedad de Alzheimer: Extracto de “Hechos y Cifras de la Enfermedad de Alzheimer 2010 (2010 Alzheimer’s Disease Facts and Figures´) de la Asociación de Alzheimer. Recuperado de: https://www.alz.org/documents_custom/ALZ_FF2010_Spanish_03.09.10.pdf
Bäckman, L.; Jones, S.; Berger, A.; Jonsson, E. y Small, B.J. (2005). Cognitive impairment in preclinical Alzheimer’s Disease: A Meta-Analysis. Neuropsychology, 19(4), 520-531. Doi: 10.1037/0894-4105.19.4.520.
Ballard, C.; Khan, Z.; Clack, H. y Corbett, A. (2011). Non-pharmacological treatment of Alzheimer’s Disease. The Canadian Journal of Psychiatry, 56(10), 589-595. doi: https://doi.org/10.1177/070674371105601004.
Basak, C.; Boot, W.; Voss, M. y Kramer, A., (2008). Can training in a real-time strategy videogame attenuate cognitive decline in older adults? Psychological Aging, 23(4), 765-777. Doi:10.1037/a0013494.
Benveniste, S.; Jouvelot, P.; Pin, B. y Péquignot, R. (2012). The MINWii project: renarcissization of patients suffering from Alzheimer’s disease through video game-based music therapy. Entertainment Computing, 3,111-120. doi: 10.1016/j.entcom.2011.12.004.
Buschert, V.; Bokde, A.L.W. y Hampel, H. (2010). Cognitive intervention in Alzheimer’s Disease. Nature Reviews Neurology, 6(9), 508-517. doi: 10.1038/nrneurol.2010.113.
Capotosto, E.; Belacchi, C.; Gardini, S.; Faggian, S.; Piras, F.; Mantoan V.; Salvalaio, E.; Pradelli, S. y Borella, E. (2017). Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia. International Journal of Geriatric Psychiatry, 32(3):331-340. doi: 10.1002/gps.4521
Chodos, A.; Johnston, B. y Yaffe, K. (2014). Dementia and Delirium. En M.D. Feldman, J.F. Christensen y J.M. Satterfield (eds.). Behavioral Medicine: a Guide for Clinical Practice. Nueva York: McGraw-Hill.
Cicerone, K.D.; Dahlberg, C.; Kalmar, K.; Langenbahn, D.M.; Malec, J.F.; Bergquist, T.F.; Felicetti, T.; Giacino, J.T.; Harley, J.P.; Harrington, D.E.; Herzog, J.; Kneipp, S.; Laatsch, L. y Morse, P.A. (2000). Evidence-based cognitive rehabilitation: recommendations for clinical practice. Archives for Physical Medical Rehabilitation, 81(12), 1596-1615. doi: 10.1053/apmr.2000.19240.
Clare, L.; Wilson, B. A.; Carter, G.; Roth, I. y Hodges, J.R. (2004). Awareness in early stage Alzheimer’s Disease: relationship to outcome cognitive rehabilitation. Journal of Clinical and Experimental Neuropsychology, 26(2), 215-226. doi: http://dx.doi.org/10.1076/jcen.26.2.215.28088.
Cove, J.; Jacobi, N.; Donovan, H.; Orrell, M.; Stott, J. y Spector, A. (2014). Effectiveness of weekly cognitive stimulation therapy for people with dementia and the additional impact of enhancing cognitive stimulation therapy with a career training program. Clinical Interventions in Aging, 9, 2143-2150. doi: http://dx.doi.org/10.2147/CIA.S66232.
D’Amico, F.; Rehill, A.; Knapp, M.; Aguirre, E.; Donovan, H.; Hoare, Z.; Hoe, J.; Russell, I.; Spector, A.; Streater, A.; Whitaker, C.; Woods, R.T. y Orrell, M. (2015). Maintenance Cognitive Stimulation Therapy: an Economic Evaluation Within a Randomized Controlled Trial. Journal of the American Medical Directors Association, 16(1), 63-70. doi: https://doi.org/10.1016/j.jamda.2014.10.020.
D’Onofrio, G.; Sancarlo, D.; Seripa, D.; Ricciardi, F.; Giuliani, F.; Panza, F. y Greco, A. (2016). Non-Pharmacological Approaches in the Treatment of Dementia. En D. Vito (ed.), Update on Dementia. doi: 10.5772/64232.
De Sánchez, C. R., Nariño, D., & Cerón, J. F. M. (2010). Epidemiología y carga de la Enfermedad de Alzheimer. Acta Neurológica Colombiana, 26(3), 1.
Fernández-Calvo, B.; Contador, I.; Serna, A; Menezes de Lucena, V. y Ramos, F. (2010). El efecto del formato de intervención individual o grupal en la estimulación cognitiva de pacientes con Enfermedad de Alzheimer. Revista de Psicopatología y Psicología Clínica, 15(2), 115-123.
Gómez. M. y Gómez, J. (2017). Musicoterapia en la enfermedad de Alzheimer: efectos cognitivos, psicológicos y conductuales. Sociedad española de neurología, 32(5), 300-308. doi: doi.org/10.1016/j.nrl.2015.12.003.
González-Arévalo, K.A. (2015). Terapia de reminiscencia y sus efectos en los pacientes mayores con demencia. Psicogeriatría, 5(3), 101-111.
Guétin, S.; Portet, F.; Picot, M.C.; Pommié, C.; Messaoudi, M.; Djabelkir, L.; Olsen, A.L.; Cano, M.M.; Lecourt, E. y Touchon, J. (2009). Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimer’s Type Dementia: Randomized, Controlled Study. Dementia and Geriatric Cognitive Disorders, 28, 36-46. Doi:10.1159/000229024.
Hall, L.; Orrell, M.; Stott, J. y Spector, A. (2013). Cognitive stimulation therapy (CST): neuropsychological mechanisms of change. International Psychogeriatrics, 25(3), 479–489. doi: 10.1017/S1041610212001822.
Hart, T. (2010). Cognitive rehabilitation. En R.G. Frank, M. Rosenthal y B. Caplan (eds.). Handbook of Rehabilitation Psychology. American Psychological Association (pp. 285-301).
Kane, R.L. (2013). Chapter 6. Delirium and Dementias. En R.L. Kane, J.G. Ouslander, I.B. Abrass y B. Resnick (eds.). Essentials of Clinical Geriatrics. Nueva York: McGraw-Hill.
Khan, Z., Corbett, A. y Ballard, C. (2014). Terapia de estimulación cognitiva: entrenamiento, mantenimiento e implementación en ensayos clínicos. Pragmatic and Observational Research, 5, 15-19. doi: https://doi.org/10.2147/POR.S56000.
Kirova, A.; Bays, R.B. y Lagalwar, S. (2015). Working memory and executive function decline across normal aging, Mild Cognitive Impairment and Alzheimer’s Disease. BioMed Research International, 1-9. doi: 10.1155/2015/748212.
Kurz, A.F.; Leucht, S. y Lautenschlager, N.T. (2011). The clinical significance of cognition-focused interventions for cognitively impaired older adults: a systematic review of randomized controlled trials. International Psychogeriatrics, 23(9), 1364-1375. doi: 10.1017/S1041610211001001.
Loewenstein, D.A.; Acevedo, A.; Czaja, S.J. y Duara, R. (2004). Cognitive rehabilitation of mildly impaired Alzheimer Disease patients on Cholinesterase inhibitors. American Journal of Geriatric Psychiatry, 12(4), 395-402. doi: 10.1176/appi.ajgp.12.4.395.
Luján, I. (2016, enero 12). La fisiopatología del Alzheimer: últimos avances. Universitat de Valencia. Recuperado de: http://www.uv.es/uvweb/master-fisiologia/es/blog/fisiopatologia-del-alzheimer-ultimos-avances-1285952573044/GasetaRecerca.html?id=1285954369657
Maci, T.; Le Pira, F.; Quattrocchi, G.; Di Nuovo, S.; Perciavalle, V. y Zappia, M. (2012). Physical and Cognitive Stimulation in Alzheimer Disease. The GAIA Project: A Pilot Study. American Journal of Alzheimer’s Disease y Other Dementias, 27(2), 107-113. doi: 10.1177/1533317512440493.
Matsuda, O. (2007). Cognitive stimulation therapy for Alzheimer’s disease: the effect of cognitive stimulation therapy on the progression of mild Alzheimer’s disease in patients treated with donepezil. International Psychogeriatrics, 19(2), 241-252. doi: https://doi.org/10.1017/S1041610206004194.
Matsuda, O.; Shido, E.; Hashikai, A.; Shibuya, H.; Kuono, M.; Hara, C. y Saito, M. (2010). Short-term effect of combined drug therapy and cognitive stimulation therapy on the cognitive function of Alzheimer’s Disease. Psychogeriatrics, 10, 167-172. doi: 10.1111/j.1479-8301.2010.00335.x.
Mesulam, M. (2015). Aphasia, Memory Loss, and Other Focal Cerebral Disorders. En D.L. Kasper, A.S. Fauci, S.L. Hauser, D.L. Longo, J.L. Jameson y J. Loscalzo (eds.). Harrison’s principles of Internal Medicine. Nueva York: McGraw-Hill. Recuperado de: http://accessmedicine.mhmedical.com.ez.unisabana.edu.co/content.aspx?bookid=1130ysectionid=79724975.
Metzler-Baddeley, C. y Snowden, J.S. (2005). Brief report: Errorless vs. Errorful learning as a memory rehabilitation approach in Alzheimer’s Disease. Journal of Clinical and Experimental Neuropsychology, 27, 1079-1079. doi: 10.1080/13803390490919164.
National Centre for Biotechnology Information. (2017). Non-drug interventions for Alzheimer’s Disease. Recuperado de: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072539/#i2219.behandlung-py.cognitivetherapyappr
Niu, Y.; Tan, J.; Guan, J.; Zhang, Z. y Wang, L. (2010). Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer’s disease: a randomized controlled trial. Clinical Rehabilitation, 24(12), 1101-1111. doi: 10.1177/0269215510376004.
Olazarán, J.; Reisberg, B.; Clare, L.; Cruz, I.; Peña-Casanova, J.; Del Ser, T.; Woods, B.; Beck, C.; Auer, S.; Lai, C.; Spector, A.; Fazio, S.; Bond, J.; Kivipelto, M.; Brodaty, J.; Rojo, J.M.; Collins, H.; Teri, L.; Mittelman, M.; Orrell, M.; Feldman, H.H. y Muñiz, R. (2010). Nonpharmacological therapies in Alzheimer’s Disease: a systematic review of efficacy. Dementia and Geriatric Cognitive Disorders, 30, 161-178. doi: https://doi.org/10.1159/000316119.
Orrell, M.; Aguirre, E.; Spector, A.; Hoare, Z.; Woods, R.T.; Streater, A.; Donovan, H.; Hoe, J., Knapp, M.; Whitaker, C. y Russell, I. (2014). British Journal of Psychiatry, 204(6), 454-461. doi: 10.1192/bjp.bp.113.137414.
Requena, C.; Maestú, F.; Campo, P.; Fernández, A.; Gil, P. y Ortiz, T. (2007). Efectos del tratamiento combinado de fármaco más estimulación cognitiva en la demencia moderada: seguimiento de dos años. Revista Española de Geriatría y Gerontología, 42(1), 3-10- doi: https://doi.org/10.1016/S0211-139X(07)73515-1.
Romero, E. (2002). Orientación, memoria y aprendizaje. En E. Romero y G. Vázquez (eds.) Actualización en Psicología Clínica. Buenos Aires: Ediciones GeKa (pp. 85-105).
Ruíz de Sánchez, C. R., Nariño, D., & Muñoz, J. F. (2010). Epidemiología y carga de la Enfermedad de Alzheimer. Acta Neurol Colomb, 26(3), 1.
Ruiz-Sánchez de León, J.M. (2012). Estimulación cognitiva en el envejecimiento sano, el deterioro cognitivo leve y las demencias: estrategias de intervención y consideraciones teóricas para la práctica clínica. Revista de Logopenia, Foniatría y Audiología, 32, 57-66. doi: 10.1016/j.rlfa.2012.02.002.
Särkämö, T. (2017). Cognitive, emotional and neural benefits of musical leisure activities in aging and neurological rehabilitation: A critical review. Annals of Physical and Rehabilitation Medicine. doi: http://dx.doi.org/10.1016/j.rehab.2017.03.006.
Saykin, A.J. y Rabin, L.A. (2014). Dementias and neurodegenerative diseases. En M.W. Parsons y T.A. Hammeke (eds.). Clinical neuropsychology: a pocket handbook for assessment. American Psychological Association (pp.237-266).
Shankar, G.M.; Li, S.; Mehta, T.H.; García-Muñoz, A.; Shepardson, N.E.; Smith, I.; Brett, F.M.; Farrell, M.A.; Rowan, M.J.; Lemere, C.A.; Regan, C.M.; Walsh, D.M.; Sabatini, B.L. y Selkoe, D.J. (2008). Amyloid β-Protein dimers isolated directly from Alzheimer’s brains impair synaptic plasticity and memory. Nature Medicine, 14(8), 837-842. doi: 10.1038/nm1782.
Spector, A.; Hoe, J.; Russell, I.T.; Knapp, M.; Woods, R.T. y Orrell, M. (2010). Maintenance Cognitive Stimulation Therapy (CST) for dementia: A single-blind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia. Trial, 11(46), 1-10. doi: https://doi.org/10.1186/1745-6215-11-46.
Spector, A.; Streater, A.; Hoe, J.; Woods, B. y Orrell, M. (2011). Making a Difference 2. Hawker Publications: UK.
Spector, A.; Thorgrimsen, L.; Woods, B.; Royan, L.; Davies, S.; Butterworth, M. y Orrell, M. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. British Journal of Psychiatry, 183, 248-254.
Stewart, D.B.; Berg-Weger, M.; Tebb, S.; Sakamoto, M.; Roselle, K.; Downing, L.; Lundy, J. y Hayden, D. (2017). Making a Difference: a Study of Cognitive Stimulation Therapy for Persons with Dementia. Journal of gerontological Social Work, 60(4), 300-312. doi: 10.1080/01634372.2017.1318196.
Takeda, M.; Tanaka, T.; Okochi, M. y Kazui, H. (2012). Non-pharmacological intervention for dementia patients. Psychiatry and Clinical Neurosciences, 66(1), 1-7. doi: 10.1111/j.1440-1819.2011.02304.x.
Tárraga, L.; Boada, M.; Modinos, G.; Espinosa, A.; Diego, S.; Morera, A.; Guitart, M.; Balcells, J.; López, O.L. y Becker, J.T. (2006). A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer’s Disease. Journal of Neurology, Neurosurgery and Psychiatry, 77(10), 1116-1121. doi: 10.1136/jnnp.2005.086074.
Thorgrimsen, L.; Woods, B. y Orrell, M. (2005). Our Time: an Evidence-Based Group Program to Offer Cognitive Stimulation to People with Dementia. Manual for Group Leaders. Cedar Falls: Freiberg Press.
Woods, B. y Orrell, M. (2008). Cognitive stimulation for the treatment of Alzheimer’s Disease. Expert Review of Neurotherapeutics, 8(5), 751-757. doi: 10.1586/14737175.8.5.751
Woods, B.; Aguirre, E.; Spector, A.E. y Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia [Review]. The Cochrane Library, 2, 1-56.
Woods, R.T.: Spector, A. y Orrell, M. (2013). Cognitive stimulation for dementia: a systematic review of the evidence of effectiveness from randomised controlled trials. Ageing Research Reviews, 12(1), 252-262. doi: https://doi.org/10.1016/j.arr.2012.07.001.
Yamanaka, K.; Kawano, Y.; Noguchi, D.; Nakaaki, S.; Watanabe, N.; Amano, T. y Spector, A. (2013). Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: a single-blind, controlled clinical trial. Aging and Mental Health, 17(5), 579-586. doi: 10.1080/13607863.2013.777395.
Yang, Y.P.; Lee, F.P.; Chao, H.C.; Hsu, F.Y. y Wang, J.J. (2016). Comparing the Effects of Cognitive Stimulation, Reminiscence, and Aroma-Massage on Agitation and Depressive Mood in People With Dementia. Journal of the American Medical Directors Association, 17(8), 719-24. doi: 10.1016/j.jamda.2016.03.021.
Yates, L.; Leung, P.; Kang, S.; Hoare, Z.; Whitaker, C.; Burns, A.; Knapp, M.; Leroi, I.; Moniz-Cook, E.; Pearson, S.; Simpson, S.; Spector, A.; Roberts, S.; Russell, I.; De Waal, H.; Woods, R.T. y Orgeta, V. (2017). The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: a randomised controlled trial. PLoS Medicine, 14(3). doi: 10.1371/journal.pmed.1002269.
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spelling Orejarena-Ballestas, María CamilaQUIÑONEZ PEREZ, ANA MILENAMarín-Gutiérrez, Alejandro2022-09-14T13:45:18Z2022-09-14T13:45:18Z2017-12-150123-9813https://repositorio.cecar.edu.co/handle/cecar/310010.21892/01239813.3722500-5766https://doi.org/10.21892/01239813.372El estudio presenta los resultados de la revisión sistemática sobre la estimulación cognitiva en el trastorno cognitivo mayor por enfermedad de Alzheimer. Se desprende que ésta encabeza las intervenciones no farmacológicas de preferencia, estando dirigida a promover el mantenimiento del estado cognitivo de las personas con condiciones neurodegenerativas. Se evidencia una tendencia a comprobar la eficacia de esta terapia, teniendo efectos positivos en la calidad de vida del paciente. Sin embargo, la heterogeneidad metodológica conlleva a diversas falencias estadísticas en varios estudios, más una ausencia de evaluación de eficacia de las tareas específicas incluidas en estos programas, lo que limita la comprobación definitiva de la eficacia de estas terapias. Se discute la relevancia del estudio del campo, considerando el contexto nacional que enmarca la labor de los profesionales, y la problemática de salud pública que caracteriza esta enfermedad.This study presents the results of a systematic review concerning the cognitive stimulation in mayor cognitive disorder associated with Alzheimer disease. The main outcome shows that cognitive stimulation entails the list of non-pharmacological therapies that is addressed at to preserving the cognitive status in patients. Secondly, this review shows the lack of agreement in the literature about the efficacy of the stimulation therapy, but in most of them the benefits spreads towards an increasing of live quality. However, the lack of methodological control has lead us to think that in some cases the therapy is not efficient because the efficacy of the specific task that have been used has not been showed. we discussed the main outcomes according to our national context, where the public-health problematic is a main problematic characteristic of this kind of disease.19 Páginasapplication/pdfspaCorporación Universitaria del Caribe - CECARSincelejohttps://revistas.cecar.edu.co/index.php/Busqueda/article/view/372/332Estimulación cognitiva para pacientes con trastorno neurocognitivo mayor por enfermedad de Alzheimer: revisión sistemáticaCognitive stimulation in Alzheimer disease patients: a systematical reviewArtículo de revistahttp://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/version/c_970fb48d4fbd8a8519114BÚSQUEDAAguirre, E.; Hoare, Z.; Streater, A.; Spector, A.; Woods, B.; Hoe, J. y Orrell, M. (2013). Cognitive stimulation therapy (CST) for people with dementia. Who benefits most? International Journal of Geriatric Psychiatry, 28(3), 284-290. doi: 10.1002/gps.3823.Alzheimer’s Association. (2017). Alzheimer's disease facts and figures. Alzheimer's y Dementia, 13(4), 325-373.Arkin, S.M. (2001). Alzheimer rehabilitation by students: interventions and outcomes. Neuropsychological Rehabilitation, 11(3/4), 273-317. doi: 10.1080/09602010143000059.Asociación Americana de Psiquiatría. (2014). Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5®). Madrid: Editorial Médica Panamericana.Asociación Americana de Psiquiatría. (2014). Manual Diagnóstico y Estadístico de los Trastornos Mentales (DSM-5®). Madrid: Editorial Médica Panamericana.Asociación de Alzheimer (2010). Reporte Especial: Raza, Etnicidad y la Enfermedad de Alzheimer: Extracto de “Hechos y Cifras de la Enfermedad de Alzheimer 2010 (2010 Alzheimer’s Disease Facts and Figures´) de la Asociación de Alzheimer. Recuperado de: https://www.alz.org/documents_custom/ALZ_FF2010_Spanish_03.09.10.pdfBäckman, L.; Jones, S.; Berger, A.; Jonsson, E. y Small, B.J. (2005). Cognitive impairment in preclinical Alzheimer’s Disease: A Meta-Analysis. Neuropsychology, 19(4), 520-531. Doi: 10.1037/0894-4105.19.4.520.Ballard, C.; Khan, Z.; Clack, H. y Corbett, A. (2011). Non-pharmacological treatment of Alzheimer’s Disease. The Canadian Journal of Psychiatry, 56(10), 589-595. doi: https://doi.org/10.1177/070674371105601004.Basak, C.; Boot, W.; Voss, M. y Kramer, A., (2008). Can training in a real-time strategy videogame attenuate cognitive decline in older adults? Psychological Aging, 23(4), 765-777. Doi:10.1037/a0013494.Benveniste, S.; Jouvelot, P.; Pin, B. y Péquignot, R. (2012). The MINWii project: renarcissization of patients suffering from Alzheimer’s disease through video game-based music therapy. Entertainment Computing, 3,111-120. doi: 10.1016/j.entcom.2011.12.004.Buschert, V.; Bokde, A.L.W. y Hampel, H. (2010). Cognitive intervention in Alzheimer’s Disease. Nature Reviews Neurology, 6(9), 508-517. doi: 10.1038/nrneurol.2010.113.Capotosto, E.; Belacchi, C.; Gardini, S.; Faggian, S.; Piras, F.; Mantoan V.; Salvalaio, E.; Pradelli, S. y Borella, E. (2017). Cognitive stimulation therapy in the Italian context: its efficacy in cognitive and non-cognitive measures in older adults with dementia. International Journal of Geriatric Psychiatry, 32(3):331-340. doi: 10.1002/gps.4521Chodos, A.; Johnston, B. y Yaffe, K. (2014). Dementia and Delirium. En M.D. Feldman, J.F. Christensen y J.M. Satterfield (eds.). Behavioral Medicine: a Guide for Clinical Practice. Nueva York: McGraw-Hill.Cicerone, K.D.; Dahlberg, C.; Kalmar, K.; Langenbahn, D.M.; Malec, J.F.; Bergquist, T.F.; Felicetti, T.; Giacino, J.T.; Harley, J.P.; Harrington, D.E.; Herzog, J.; Kneipp, S.; Laatsch, L. y Morse, P.A. (2000). Evidence-based cognitive rehabilitation: recommendations for clinical practice. Archives for Physical Medical Rehabilitation, 81(12), 1596-1615. doi: 10.1053/apmr.2000.19240.Clare, L.; Wilson, B. A.; Carter, G.; Roth, I. y Hodges, J.R. (2004). Awareness in early stage Alzheimer’s Disease: relationship to outcome cognitive rehabilitation. Journal of Clinical and Experimental Neuropsychology, 26(2), 215-226. doi: http://dx.doi.org/10.1076/jcen.26.2.215.28088.Cove, J.; Jacobi, N.; Donovan, H.; Orrell, M.; Stott, J. y Spector, A. (2014). Effectiveness of weekly cognitive stimulation therapy for people with dementia and the additional impact of enhancing cognitive stimulation therapy with a career training program. Clinical Interventions in Aging, 9, 2143-2150. doi: http://dx.doi.org/10.2147/CIA.S66232.D’Amico, F.; Rehill, A.; Knapp, M.; Aguirre, E.; Donovan, H.; Hoare, Z.; Hoe, J.; Russell, I.; Spector, A.; Streater, A.; Whitaker, C.; Woods, R.T. y Orrell, M. (2015). Maintenance Cognitive Stimulation Therapy: an Economic Evaluation Within a Randomized Controlled Trial. Journal of the American Medical Directors Association, 16(1), 63-70. doi: https://doi.org/10.1016/j.jamda.2014.10.020.D’Onofrio, G.; Sancarlo, D.; Seripa, D.; Ricciardi, F.; Giuliani, F.; Panza, F. y Greco, A. (2016). Non-Pharmacological Approaches in the Treatment of Dementia. En D. Vito (ed.), Update on Dementia. doi: 10.5772/64232.De Sánchez, C. R., Nariño, D., & Cerón, J. F. M. (2010). Epidemiología y carga de la Enfermedad de Alzheimer. Acta Neurológica Colombiana, 26(3), 1.Fernández-Calvo, B.; Contador, I.; Serna, A; Menezes de Lucena, V. y Ramos, F. (2010). El efecto del formato de intervención individual o grupal en la estimulación cognitiva de pacientes con Enfermedad de Alzheimer. Revista de Psicopatología y Psicología Clínica, 15(2), 115-123.Gómez. M. y Gómez, J. (2017). Musicoterapia en la enfermedad de Alzheimer: efectos cognitivos, psicológicos y conductuales. Sociedad española de neurología, 32(5), 300-308. doi: doi.org/10.1016/j.nrl.2015.12.003.González-Arévalo, K.A. (2015). Terapia de reminiscencia y sus efectos en los pacientes mayores con demencia. Psicogeriatría, 5(3), 101-111.Guétin, S.; Portet, F.; Picot, M.C.; Pommié, C.; Messaoudi, M.; Djabelkir, L.; Olsen, A.L.; Cano, M.M.; Lecourt, E. y Touchon, J. (2009). Effect of Music Therapy on Anxiety and Depression in Patients with Alzheimer’s Type Dementia: Randomized, Controlled Study. Dementia and Geriatric Cognitive Disorders, 28, 36-46. Doi:10.1159/000229024.Hall, L.; Orrell, M.; Stott, J. y Spector, A. (2013). Cognitive stimulation therapy (CST): neuropsychological mechanisms of change. International Psychogeriatrics, 25(3), 479–489. doi: 10.1017/S1041610212001822.Hart, T. (2010). Cognitive rehabilitation. En R.G. Frank, M. Rosenthal y B. Caplan (eds.). Handbook of Rehabilitation Psychology. American Psychological Association (pp. 285-301).Kane, R.L. (2013). Chapter 6. Delirium and Dementias. En R.L. Kane, J.G. Ouslander, I.B. Abrass y B. Resnick (eds.). Essentials of Clinical Geriatrics. Nueva York: McGraw-Hill.Khan, Z., Corbett, A. y Ballard, C. (2014). Terapia de estimulación cognitiva: entrenamiento, mantenimiento e implementación en ensayos clínicos. Pragmatic and Observational Research, 5, 15-19. doi: https://doi.org/10.2147/POR.S56000.Kirova, A.; Bays, R.B. y Lagalwar, S. (2015). Working memory and executive function decline across normal aging, Mild Cognitive Impairment and Alzheimer’s Disease. BioMed Research International, 1-9. doi: 10.1155/2015/748212.Kurz, A.F.; Leucht, S. y Lautenschlager, N.T. (2011). The clinical significance of cognition-focused interventions for cognitively impaired older adults: a systematic review of randomized controlled trials. International Psychogeriatrics, 23(9), 1364-1375. doi: 10.1017/S1041610211001001.Loewenstein, D.A.; Acevedo, A.; Czaja, S.J. y Duara, R. (2004). Cognitive rehabilitation of mildly impaired Alzheimer Disease patients on Cholinesterase inhibitors. American Journal of Geriatric Psychiatry, 12(4), 395-402. doi: 10.1176/appi.ajgp.12.4.395.Luján, I. (2016, enero 12). La fisiopatología del Alzheimer: últimos avances. Universitat de Valencia. Recuperado de: http://www.uv.es/uvweb/master-fisiologia/es/blog/fisiopatologia-del-alzheimer-ultimos-avances-1285952573044/GasetaRecerca.html?id=1285954369657Maci, T.; Le Pira, F.; Quattrocchi, G.; Di Nuovo, S.; Perciavalle, V. y Zappia, M. (2012). Physical and Cognitive Stimulation in Alzheimer Disease. The GAIA Project: A Pilot Study. American Journal of Alzheimer’s Disease y Other Dementias, 27(2), 107-113. doi: 10.1177/1533317512440493.Matsuda, O. (2007). Cognitive stimulation therapy for Alzheimer’s disease: the effect of cognitive stimulation therapy on the progression of mild Alzheimer’s disease in patients treated with donepezil. International Psychogeriatrics, 19(2), 241-252. doi: https://doi.org/10.1017/S1041610206004194.Matsuda, O.; Shido, E.; Hashikai, A.; Shibuya, H.; Kuono, M.; Hara, C. y Saito, M. (2010). Short-term effect of combined drug therapy and cognitive stimulation therapy on the cognitive function of Alzheimer’s Disease. Psychogeriatrics, 10, 167-172. doi: 10.1111/j.1479-8301.2010.00335.x.Mesulam, M. (2015). Aphasia, Memory Loss, and Other Focal Cerebral Disorders. En D.L. Kasper, A.S. Fauci, S.L. Hauser, D.L. Longo, J.L. Jameson y J. Loscalzo (eds.). Harrison’s principles of Internal Medicine. Nueva York: McGraw-Hill. Recuperado de: http://accessmedicine.mhmedical.com.ez.unisabana.edu.co/content.aspx?bookid=1130ysectionid=79724975.Metzler-Baddeley, C. y Snowden, J.S. (2005). Brief report: Errorless vs. Errorful learning as a memory rehabilitation approach in Alzheimer’s Disease. Journal of Clinical and Experimental Neuropsychology, 27, 1079-1079. doi: 10.1080/13803390490919164.National Centre for Biotechnology Information. (2017). Non-drug interventions for Alzheimer’s Disease. Recuperado de: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072539/#i2219.behandlung-py.cognitivetherapyapprNiu, Y.; Tan, J.; Guan, J.; Zhang, Z. y Wang, L. (2010). Cognitive stimulation therapy in the treatment of neuropsychiatric symptoms in Alzheimer’s disease: a randomized controlled trial. Clinical Rehabilitation, 24(12), 1101-1111. doi: 10.1177/0269215510376004.Olazarán, J.; Reisberg, B.; Clare, L.; Cruz, I.; Peña-Casanova, J.; Del Ser, T.; Woods, B.; Beck, C.; Auer, S.; Lai, C.; Spector, A.; Fazio, S.; Bond, J.; Kivipelto, M.; Brodaty, J.; Rojo, J.M.; Collins, H.; Teri, L.; Mittelman, M.; Orrell, M.; Feldman, H.H. y Muñiz, R. (2010). Nonpharmacological therapies in Alzheimer’s Disease: a systematic review of efficacy. Dementia and Geriatric Cognitive Disorders, 30, 161-178. doi: https://doi.org/10.1159/000316119.Orrell, M.; Aguirre, E.; Spector, A.; Hoare, Z.; Woods, R.T.; Streater, A.; Donovan, H.; Hoe, J., Knapp, M.; Whitaker, C. y Russell, I. (2014). British Journal of Psychiatry, 204(6), 454-461. doi: 10.1192/bjp.bp.113.137414.Requena, C.; Maestú, F.; Campo, P.; Fernández, A.; Gil, P. y Ortiz, T. (2007). Efectos del tratamiento combinado de fármaco más estimulación cognitiva en la demencia moderada: seguimiento de dos años. Revista Española de Geriatría y Gerontología, 42(1), 3-10- doi: https://doi.org/10.1016/S0211-139X(07)73515-1.Romero, E. (2002). Orientación, memoria y aprendizaje. En E. Romero y G. Vázquez (eds.) Actualización en Psicología Clínica. Buenos Aires: Ediciones GeKa (pp. 85-105).Ruíz de Sánchez, C. R., Nariño, D., & Muñoz, J. F. (2010). Epidemiología y carga de la Enfermedad de Alzheimer. Acta Neurol Colomb, 26(3), 1.Ruiz-Sánchez de León, J.M. (2012). Estimulación cognitiva en el envejecimiento sano, el deterioro cognitivo leve y las demencias: estrategias de intervención y consideraciones teóricas para la práctica clínica. Revista de Logopenia, Foniatría y Audiología, 32, 57-66. doi: 10.1016/j.rlfa.2012.02.002.Särkämö, T. (2017). Cognitive, emotional and neural benefits of musical leisure activities in aging and neurological rehabilitation: A critical review. Annals of Physical and Rehabilitation Medicine. doi: http://dx.doi.org/10.1016/j.rehab.2017.03.006.Saykin, A.J. y Rabin, L.A. (2014). Dementias and neurodegenerative diseases. En M.W. Parsons y T.A. Hammeke (eds.). Clinical neuropsychology: a pocket handbook for assessment. American Psychological Association (pp.237-266).Shankar, G.M.; Li, S.; Mehta, T.H.; García-Muñoz, A.; Shepardson, N.E.; Smith, I.; Brett, F.M.; Farrell, M.A.; Rowan, M.J.; Lemere, C.A.; Regan, C.M.; Walsh, D.M.; Sabatini, B.L. y Selkoe, D.J. (2008). Amyloid β-Protein dimers isolated directly from Alzheimer’s brains impair synaptic plasticity and memory. Nature Medicine, 14(8), 837-842. doi: 10.1038/nm1782.Spector, A.; Hoe, J.; Russell, I.T.; Knapp, M.; Woods, R.T. y Orrell, M. (2010). Maintenance Cognitive Stimulation Therapy (CST) for dementia: A single-blind, multi-centre, randomized controlled trial of Maintenance CST vs. CST for dementia. Trial, 11(46), 1-10. doi: https://doi.org/10.1186/1745-6215-11-46.Spector, A.; Streater, A.; Hoe, J.; Woods, B. y Orrell, M. (2011). Making a Difference 2. Hawker Publications: UK.Spector, A.; Thorgrimsen, L.; Woods, B.; Royan, L.; Davies, S.; Butterworth, M. y Orrell, M. (2003). Efficacy of an evidence-based cognitive stimulation therapy programme for people with dementia. British Journal of Psychiatry, 183, 248-254.Stewart, D.B.; Berg-Weger, M.; Tebb, S.; Sakamoto, M.; Roselle, K.; Downing, L.; Lundy, J. y Hayden, D. (2017). Making a Difference: a Study of Cognitive Stimulation Therapy for Persons with Dementia. Journal of gerontological Social Work, 60(4), 300-312. doi: 10.1080/01634372.2017.1318196.Takeda, M.; Tanaka, T.; Okochi, M. y Kazui, H. (2012). Non-pharmacological intervention for dementia patients. Psychiatry and Clinical Neurosciences, 66(1), 1-7. doi: 10.1111/j.1440-1819.2011.02304.x.Tárraga, L.; Boada, M.; Modinos, G.; Espinosa, A.; Diego, S.; Morera, A.; Guitart, M.; Balcells, J.; López, O.L. y Becker, J.T. (2006). A randomised pilot study to assess the efficacy of an interactive, multimedia tool of cognitive stimulation in Alzheimer’s Disease. Journal of Neurology, Neurosurgery and Psychiatry, 77(10), 1116-1121. doi: 10.1136/jnnp.2005.086074.Thorgrimsen, L.; Woods, B. y Orrell, M. (2005). Our Time: an Evidence-Based Group Program to Offer Cognitive Stimulation to People with Dementia. Manual for Group Leaders. Cedar Falls: Freiberg Press.Woods, B. y Orrell, M. (2008). Cognitive stimulation for the treatment of Alzheimer’s Disease. Expert Review of Neurotherapeutics, 8(5), 751-757. doi: 10.1586/14737175.8.5.751Woods, B.; Aguirre, E.; Spector, A.E. y Orrell, M. (2012). Cognitive stimulation to improve cognitive functioning in people with dementia [Review]. The Cochrane Library, 2, 1-56.Woods, R.T.: Spector, A. y Orrell, M. (2013). Cognitive stimulation for dementia: a systematic review of the evidence of effectiveness from randomised controlled trials. Ageing Research Reviews, 12(1), 252-262. doi: https://doi.org/10.1016/j.arr.2012.07.001.Yamanaka, K.; Kawano, Y.; Noguchi, D.; Nakaaki, S.; Watanabe, N.; Amano, T. y Spector, A. (2013). Effects of cognitive stimulation therapy Japanese version (CST-J) for people with dementia: a single-blind, controlled clinical trial. Aging and Mental Health, 17(5), 579-586. doi: 10.1080/13607863.2013.777395.Yang, Y.P.; Lee, F.P.; Chao, H.C.; Hsu, F.Y. y Wang, J.J. (2016). Comparing the Effects of Cognitive Stimulation, Reminiscence, and Aroma-Massage on Agitation and Depressive Mood in People With Dementia. Journal of the American Medical Directors Association, 17(8), 719-24. doi: 10.1016/j.jamda.2016.03.021.Yates, L.; Leung, P.; Kang, S.; Hoare, Z.; Whitaker, C.; Burns, A.; Knapp, M.; Leroi, I.; Moniz-Cook, E.; Pearson, S.; Simpson, S.; Spector, A.; Roberts, S.; Russell, I.; De Waal, H.; Woods, R.T. y Orgeta, V. (2017). The impact of individual Cognitive Stimulation Therapy (iCST) on cognition, quality of life, caregiver health, and family relationships in dementia: a randomised controlled trial. 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